Alexander McQueen post mortem reveals sad story of highs and lows

The balance of Alexander McQueen's mind was disturbed when he hanged himself, the coroner Dr Paul Knapman has determined. And toxicology has found that the fashion designer had taken sedative drugs and cocaine before he died of asphyxiation and hanging. He was discovered on February 11. His mother's funeral was to take place the following day.

Dr Stephen Pereira, his psychiatrist, told the inquest about the ups and downs of the designer's life and work and said he had a diagnosis of mixed anxiety and depressive disorder.

In the reports, Dr Pereira describes a very sad story of oscillation of mood, between the highs of McQueen's acclaimed fashion shows and crashing depressions afterwards. It must often be the case with highly successful individuals that they fear they are valued only for their work. Praise itself can be double-edged. The recipient of extravagant praise may wonder: am I valued only for my achievements? Or for who I am "deep down"?

The other thing to note about McQueen's death is the presence of cocaine and tranquillisers. Tranquillisers, especially benzodiazepines such as Valium or Librium, are not thought to be a good idea in depressed individuals. The trouble is, depressed persons often suffer anxiety as well, and these drugs work well in anxiety so they may be prescribed anyway.

Cocaine is a major risk factor for suicide. Using the stimulant drug can only have exaggerated, with perilous effect, the lurches up and down that McQueen was apparently experiencing. All in all, it sounds as though the designer was in a miserable state of mind.